For the first time in California, a bill has been passed that more or less clearly defines the term medical necessity. What this means is that there will be more clear cut guidelines regarding what sort of health problems – particularly mental health problems – which are deemed appropriate for insurance.
This could have a profound impact on rehab centers in San Diego and the people who are relying on them for seeking treatment. The bill, which expands upon the number of conditions liable to be treated with insurance, may provide improvements in the lives of many people.
What Is Senate Bill 855?
The full title of the bill is Senate Bill 855, Health Coverage: mental health or substance use disorders. When it was signed into law on September 25th by California’s governor, insurance providers became more obligated to provide coverage for a variety of conditions related to drug addiction, substance abuse, and mental health disorders that may not have previously been covered.
California is already fairly well-known for its comparatively expensive mental health treatment programs. Several laws, such as the Mental Health Parity Act signed in 1999 or the Federal Mental Health Parity & Addiction Equity Act, provide a significant degree of coverage for people struggling with serious mental illnesses when compared to other states. These bills included mental health problems categorized as severe, as well as emotionally disturbed children and serious drug addiction.
However, the signing of Bill 855 provides even more of a safety net for some of California’s at-risk citizens. While the aforementioned bills provided parity for people struggling with severe mental health problems, they did not cover conditions that were not considered severe. Some of these conditions, despite not being recognized as severe, include potentially life-threatening conditions such as drug use, alcoholism, PTSD, and anxiety.
The Issue of Medical Necessity
So why, exactly, did we need to pass a new bill? If California’s policies already provided more insurance parity than most other states, why would we need further legislation?
One of the reasons for this is because of the lack of definition for the term ‘medically necessary.’ While the previous bills required that insurance companies provide parity for medically necessary treatments, be they mental or physical, they do not actually specify what constitutes a medically necessary condition.
Because of this, insurance companies are known to decline insurance requests arbitrarily. The passing of this new bill defines the term ‘medically necessary.’
How This Affects Rehab Centers in San Diego
Now that medically necessary drug and alcohol conditions must be covered by insurance companies, there is bound to be a significant increase in the number of patients seeing treatment. The criteria used to assess whether or not addiction is medically necessary will be set by a professional organization like the American Society of Addiction Medicine.
Ultimately, this bill aims to ensure that people can get their treatment covered before it’s too late. Rather than waiting until a drug user is suffering from myriad physical and mental health problems, Bill 855 recognizes that drug addiction, at any stage, can be just as threatening.
If you or a loved one are struggling with drug addiction, don’t hesitate to seek treatment. With the passing of Senate Bill 855, more patients are liable to receive insurance parity for their addiction treatment. This could save lives.